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Meta-Analysis
. 2021 Jun;48(6):1876-1889.
doi: 10.1007/s00259-020-05162-6. Epub 2020 Dec 28.

Diagnostic value of [18F]FDG-PET/CT in polymyalgia rheumatica: a systematic review and meta-analysis

K S M van der Geest  1 , G Treglia  2   3   4   5 , A W J M Glaudemans  6 , E Brouwer  7 , F Jamar  8 , R H J A Slart  6   9 , O Gheysens  8
Affiliations
Meta-Analysis

Diagnostic value of [18F]FDG-PET/CT in polymyalgia rheumatica: a systematic review and meta-analysis

K S M van der Geest et al. Eur J Nucl Med Mol Imaging. 2021 Jun.

Abstract

Purpose: Polymyalgia rheumatica (PMR) can be difficult to diagnose. Whole-body [18F]FDG-PET/CT allows for a comprehensive evaluation of all relevant articular and extra-articular structures affected by PMR. We aimed to summarize current evidence on the diagnostic value of [18F]FDG-PET/CT for a diagnosis of PMR.

Methods: PubMed/MEDLINE and the Cochrane Library database were searched from inception through May 31, 2020. Studies containing patients with PMR who underwent [18F]FDG-PET/CT were included. Screening and full-text review were performed by 3 investigators and data extraction by 2 investigators. Risk of bias was examined with the QUADAS-2 tool. Diagnostic test meta-analysis was performed with a bivariate model.

Results: Twenty studies were included in the systematic review, of which 9 studies (n = 636 patients) were eligible for meta-analysis. [18F]FDG positivity at the following sites was associated with a diagnosis of PMR: interspinous bursae (positive likelihood ratio (LR+) 4.00; 95% CI 1.84-8.71), hips (LR+ 2.91; 95% CI 2.09-4.05), ischial tuberosities (LR+ 2.86; 95% CI 1.91-4.28), shoulders (LR+ 2.57; 95% CI 1.24-5.32) and sternoclavicular joints (LR+ 2.31; 95% CI 1.33-4.02). Negative likelihood ratios (LR-) for these sites, as well as the greater trochanters, were all less than 0.50. Composite [18F]FDG-PET/CT scores, as reported in 3 studies, provided a pooled LR+ of 3.91 (95% CI 2.42-6.32) and LR- of 0.19 (95% CI 0.10-0.36). Moderate to high heterogeneity was observed across the studies, mainly due to differences in patient selection, scanning procedures and/or interpretation criteria.

Conclusion: Significant [18F]FDG uptake at a combination of anatomic sites is informative for a diagnosis of PMR. [18F]FDG-PET/CT might be an important diagnostic tool in patients with suspected PMR. This study also highlights the need for adherence to published procedural recommendations and standardized interpretation criteria for the use of [18F]FDG-PET/CT in PMR.

Keywords: Fluorodeoxyglucose F18; Meta-analysis; Polymyalgia rheumatica; Positron emission tomography/computed tomography; Review.

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Conflict of interest statement

Dr. van der Geest has received a speaker fee from Roche paid to the UMCG. Dr. Brouwer has received consultancy and speaker fees from Roche paid to the UMCG. The other authors have no disclosures.

Figures

Fig. 1
Fig. 1
Study selection flowchart
Fig. 2
Fig. 2
Summary of QUADAS-2 items for the 9 studies included in the meta-analysis
Fig. 3
Fig. 3
Forest plots showing the sensitivity and specificity of [18F]FDG-PET/CT for PMR. Data are shown for the anatomic sites reported by at least 4 unique studies. VIS visual uptake, OP oncologic patients, ORD patients with other rheumatic disease, RA patients with rheumatoid arthritis, SpA patients with spondyloarthritis, MBP mediastinal blood pool
See this image and copyright information in PMC

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